Apr 13, 2023
Medi-Cal Renewal matters to group clients too. Meet Bill
This is the second in our series of short scenarios you may encounter as Medi-Cal eligibility reviews restart and clients look to you for support.
Meet Bill, the chef at a local restaurant that is one of your Small Group clients. Here is his Medi-Cal renewal story.
Bill loses group health plan coverage and enrolls in Medi-Cal
In 2020, the COVID-19 pandemic forced the restaurant to close in-person dining. Bill became a part-time employee, and he no longer qualified for his company-sponsored health plan.
Bill enrolls in Medi-Cal
Bill’s income dropped to a fraction of what he was making before the pandemic. He became eligible for Medi-Cal and enrolled.
Bill loses Medi-Cal eligibility
Now in 2023, the restaurant’s business is booming, Bill is back to work full-time and received a pay raise. Medi-Cal eligibility reviews have started, and during Bill’s redetermination he is informed he earns too much to remain on Medi-Cal.
Bill can enroll in group health coverage again
Since losing Medi-Cal coverage is a qualifying event entitling Bill to a special enrollment period, Bill is eligible to sign up for the restaurant’s group health plan up to 60 days before or 60 days after he loses coverage. The restaurant, your group client, can log into EmployerAccess to add Bill back on their plan.
For more assistance with tools and resources to help you guide and support clients like Bill and his employer, visit the Medi-Cal Renewal Broker Solutions Kit.
* Bill’s story represents a potential member journey and is hypothetical in nature.